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NPI Code Detail

MEDICARE: MS. PATRICIA AZZARELLI LYNCH CNP

MEDICARE: MS. PATRICIA AZZARELLI LYNCH CNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207V00000XObstetrics & Gynecology Physician309001044IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1309001044OTHERILNP LICENSE NUMBER

General Provider Information

NPI Number : 1104811660
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PATRICIA AZZARELLI LYNCH CNP
Provider Business Mailing Address
First Line : 375 N WALL ST
Second Line : STE P410
City : KANKAKEE
State : IL
Zip : 60901-3483
Country : US
Telephone Number : 815-932-7474
Fax Number : 815-937-8206
Provider Business Practice Location Address
First Line : 375 N WALL ST
Second Line : STE P410
City : KANKAKEE
State : IL
Zip : 60901-3483
Country : US
Telephone Number : 815-932-7474
Fax Number : 815-937-8206
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2005
Last Update Date : 05/22/2008

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